Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Department of Surgery, 5506Medical College of Wisconsin, Milwaukee, WI, USA.
Am Surg. 2022 Feb;88(2):205-211. doi: 10.1177/0003134820988820. Epub 2021 Jan 27.
Nonoperative management of adhesive small bowel obstruction (SBO) is successful in up to 80% of patients. Current recommendations advocate for computed tomography (CT) scan in all patients with SBO to supplement surgical decision-making. The hypothesis of this study was that cumulative findings on CT would predict the need for operative intervention in the setting of SBO.
This is an analysis of a retrospectively and prospectively collected adhesive SBO database over a 6-year period. A Bowel Ischemia Score (BIS) was developed based on the Eastern Association for the Surgery of Trauma guidelines of CT findings suggestive of bowel ischemia. One point was assigned for each of the six variables. Early operation was defined as surgery within 6 hours of CT scan.
Of the 275 patients in the database, 249 (90.5%) underwent CT scan. The operative rate was 28.3% with a median time from CT to operation of 21 hours (Interquartile range 5.2-59.2 hours). Most patients (166/217, 76.4%) with a BIS of 0 or 1 were successfully managed nonoperatively, whereas the majority of those with a BIS of 3 required operative intervention (5/6, 83.3%). The discrimination (area under the receiver operating characteristic curve) of BIS for early surgery, any operative intervention, and small bowel resection were 0.83, 0.72, and 0.61, respectively.
The cumulative signs of bowel ischemia on CT scan represented by BIS, rather than the presence or absence of any one finding, correlate with the need for early operative intervention.
非手术治疗粘连性小肠梗阻（SBO）在多达 80%的患者中是成功的。目前的建议主张对所有 SBO 患者进行计算机断层扫描（CT）以补充手术决策。本研究的假设是，CT 上的累积发现将预测 SBO 患者需要手术干预。
这是一项对 6 年期间回顾性和前瞻性收集的粘连性 SBO 数据库的分析。根据东部创伤外科学会（Eastern Association for the Surgery of Trauma）关于提示肠缺血的 CT 发现的指南，开发了肠缺血评分（Bowel Ischemia Score，BIS）。每个变量记 1 分。早期手术定义为 CT 扫描后 6 小时内进行的手术。
数据库中的 275 名患者中，有 249 名（90.5%）进行了 CT 扫描。手术率为 28.3%，从 CT 到手术的中位时间为 21 小时（四分位距 5.2-59.2 小时）。大多数 BIS 为 0 或 1 的患者（166/217，76.4%）成功接受非手术治疗，而大多数 BIS 为 3 的患者需要手术干预（5/6，83.3%）。BIS 对早期手术、任何手术干预和小肠切除的鉴别能力（接受者操作特征曲线下的面积）分别为 0.83、0.72 和 0.61。
CT 扫描上肠缺血的累积征象，用 BIS 表示，而不是任何一个征象的存在与否，与早期手术干预的需要相关。
